Provider Demographics
NPI:1487064200
Name:DAVINCI MEDICAL WEIGHT LOSS & WELLNESS CENTER
Entity type:Organization
Organization Name:DAVINCI MEDICAL WEIGHT LOSS & WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER- NUTRITIONIST/ CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-840-0474
Mailing Address - Street 1:19641 E PARKER SQUARE DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7399
Mailing Address - Country:US
Mailing Address - Phone:303-840-0474
Mailing Address - Fax:800-707-4541
Practice Address - Street 1:19641 E PARKER SQUARE DR
Practice Address - Street 2:SUITE H
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7399
Practice Address - Country:US
Practice Address - Phone:303-840-0474
Practice Address - Fax:800-707-4541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0006031-NP261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty